I walk into the room kind of excited as I enjoy the artistic component of restoring injured tissue. Anthony was one of those instantly likable kids—very respectful, contagious smile, intelligent and quick-witted. He had broken up a knife fight between two older girls at his high school and received a pretty extensive forearm slash in the process. It was deep and required a multilevel repair, internal and external sutures about 40 in total. It takes time to complete a repair like this; so we talk about sports, where we grew up, brothers and sisters- male bonding 101.

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I got to know him well considering the setting; a good kid in the wrong place. I finished up, gave him return precautions and wished him the best, genuinely hoping he would be able to rise above his circumstances.

Three months later he was escorted in by two cops, handcuffed, but again respectful and cooperative. He had been picked up for using marijuana and they needed medical clearance to process him as he was still a little high. Hey, I said he was a good kid, not perfect. I immediately notice my sutures still in place. “Anthony, dude, I told you to come back and get these taken out in 10-12 days!” “My bad sir, it look good though Doc. You got skills, thank you for fittin' me up.” Can’t help but like the kid. I sit down; take out all the external sutures, the wound healed incredibly well considering its depth and size, which makes me happy. We small talk some, I give some life advice about good choices and staying out of trouble, Anthony seems very receptive, thanks me again and I release him to the police.

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A year or so passes.

“Level one penetrating, ETA 7 minutes” blares across the overhead trauma pager. I go to the resuscitation bay and start prepping equipment waiting for more details. It’s going to be a 16 yr old male, GSW (Gunshot wound) to the face, coming from a house party, unconscious but hemodynamically stable (the heart rate and blood pressure are in an acceptable range to support life). EMS arrives and our all too practiced orchestra proceeds.

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Everyone is performing their role simultaneously—the nurses to get IV access, draw labs and get the patient on a monitor; the trauma surgeons assessing the body, need for immediate hemorrhage control, and what imaging needs to ensue; then myself at the head of the bed addressing airway, breathing, head and face injuries. I pass a breathing tube into his trachea to protect him from choking on his own secretions and from an ER standpoint the patient is stabilized and ready to go to the CT scanner. We are a level 1 trauma referral center and are good at what we do. The resuscitation runs very smoothly- focused, controlled, and efficient.

In the time lapsed for initial stabilization our registration team has obtained demographic information and created patient stickers. The name looked familiar but I couldn’t place it. As adrenaline cooled and my mind started to marry words and images, it hit me. That was Anthony. The good kid with the contagious smile who was prone to being in the wrong place had just been shot in the face and was only going to be able to continue his expression of life in any form through organ donation (if the family chooses to do so).

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I felt flushed, could feel my heart beat, could feel each breath. I walked straight to the bathroom shut the door, leaned over the sink, and glared into my own dilated eyes looking back from the mirror. Focus Ballard. Get your shit together. Deal with it later. Two deep deliberate breaths and I left the bathroom and walked into the next patient’s room.

Head up, hand out to shake, smile, eye contact: “Hello ma'am, I'm Dr. Ballard, I’ll be taking care of you today. What brings you in?”

It’s pretty rare I cry.

That night was an exception. I sat alone on my balcony drinking a Coors Light listening to to my finely tuned Waylon Jennings Pandora station with a lot of the good stuff from Kris Kristofferson, Jonny Cash and Willie Nelson. I stared blankly into the dark.

I genuinely love my work. I do not love everything about it.

Jedidiah BallardJedidiah Ballard, D.O.,is an emergency room doctor and former Army Ranger medic.

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